Each year, about half a million Americans are diagnosed with Clostridioides difficile, a common bacterial infection of the large intestine. Only some patients respond to antibiotics. Infection recurs in about 20% of patients and proves fatal in about 30,000 cases annually.  But there is a highly effective, albeit unconventional, treatment: fecal microbiota transplantation (FMT), which involves transplanting healthy stool into a patient’s gut. Although FMT is approved in many countries, access is still limited. In Europe, for example, only one in 10 patients with recurrent C. difficile is able to get FMT treatment.  Access for children is especially challenging. Most banks collect samples only from adults, and transplanting them into children may cause unwanted side effects. Nikhil Pai, a pediatric gastroenterologist at McMaster Children’s Hospital and associate professor at McMaster University, is helping to change things. In 2022, he set up the first pediatric stool bank in Canada. Since then, the bank has stored more than 150 samples and completed five FMT procedures in children. Pai is collaborating with other researchers on designing oral “crapsules” to make treatment easier.  Managing a stool bank: Pai and his colleagues take on multiple roles to keep the bank running. They recruit and screen donors, catalogue the samples, store them in a freezer at −80 °C,and fundraise to keep the effort going. The bank also provides stool to researchers testing FMT as a treatment for other diseases. “There’s a lot of different roles that we’ve taken on to be able to do this,” Pai says. From donation to treatment: The bank recruits donors throughout the hospital. The healthy siblings of patients or children of hospital staff are eager to help. “There is a very strong sense of citizenship that leads children to want to volunteer,” he says.  To ensure that their stool is healthy, donors are screened via a questionnaire and a blood test. Their stool is also tested for infectious diseases like HIV, SARS-CoV-2, and hepatitis. The bank matches each new patient with healthy stool from a donor of the same age and sex. The treatment is delivered via enema. Pai says there’s an 80% success rate after one treatment and more than 90% after a second.  Easing access: Pai says it’s crucial to fund stool banks so patients don’t need to travel far for treatment. And he’s hopeful that oral crapsules will make life easier for patients. Rather than needing to travel to a hospital with specialized personnel for an enema or endoscopy, they could take these like any other pill. One day, the treatment could extend to a range of other drug-resistant infections and gut diseases. Simon Spichak is a freelance science, health, and tech journalist based in Toronto.